Americans Spend Billions on Vitamins and Herbs That Don’t Work

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Most of our unhealthy habits stem from doing what’s easier or cheaper. But there’s nothing cheap or easy about taking vitamins and herbal supplements — and there’s no credible evidence they offer any benefits for the average person.

Anyone walking into a grocery store can quickly see that
dietary supplements are big business. Vitamins and herbal supplements command a
significant chunk of floor space.

The pills, capsules, and powders make up 5 percent of all
grocery sales in the United States. Their profit margins, however, are about 10
times as high as those of food items.

Are You Getting Duped?

50% of Americans take multivitamins.

1 in 5 U.S. adults takes herbal supplements.

Americans will spend $21 billion on supplements in 2015.

The U.S. Preventive Services Task Force doesn't recommend regular use of any multivitamins or herbs.

The FDA only spot tests 1% of the 65,000 dietary supplements on the market.

Supplements, in fact, keep many small natural groceries in
business, according to James Johnson, a senior market analyst for the trade
publication Nutrition Business Journal.

Most Americans, hoping to improve their health, spend some
of their hard-earned cash on these products.

About half of Americans take multivitamins. Many also take
individual vitamin supplements. And roughly one in five U.S. adults uses herbal
supplements.

All told, Americans will spend $21 billion on vitamins and
herbal supplements in 2015. If protein powders are included, supplements are as
big a market as all
organic foods combined.

Vitamins Can’t Compensate for Poor Diet

Many of the shortcomings in the American diet are linked to
economics. We eat fast food because it’s cheap. We buy more processed foods and
fewer fruits and vegetables because the packaged goods cost less and keep
longer.

We gripe about the price tag on organic foods. Then we spend
$21 billion a year — 9 cents for every adult
in the nation — on products that are neither tasty nor cheap in hopes they will
counter the damage we’ve done.

And American consumers do this almost entirely on their own.

The U.S. Preventive Services Task Force (USPSTF), an
independent group of doctors, opted in 2013 not to recommend regular use of any
multivitamins. It doesn’t recommend the use of any herbal supplements, and it advises
consumers not to take beta-carotene or vitamin
E.

In 2011, the Iowa Women’s Health Study found
that, when other variables were excluded, those who took vitamins died sooner
than those who didn’t. Only vitamin B and calcium had a small positive effect.
The study followed more than 38,000 women for 20 years.

Herbal supplements are difficult to test, Dr. Carol Haggans, RD,
of the Office of Dietary Supplements at the National Institutes of Health, told
Healthline. There are multiple species of many common herbs on store shelves,
and products often include more than one part of the plant.

Steve Mister, president of the supplements industry group
the Council for Responsible Nutrition (CRN), agreed with Haggans’ assessment. Asked
to cite herbs for which he’d seen compelling evidence, he named saw palmetto
and echinacea but acknowledged that research studies have reached contradictory
conclusions. Mark Blumenthal, founder
and executive director of the American Botanical Council, mentioned St.
John’s Wort to treat major depression, but research is mixed for it as well.

But there’s no lack of research on vitamins. Several large,
long-term studies have failed to come up with evidence to suggest there’s any
reason to take multivitamins or any of the common single-letter vitamins as a
preventative measure.

The supplements industry finds fault with the science.
Mister pointed instead to an
outlier study that did find that multivitamins reduced the risk of cancer in an older and largely male study group of physicians.

A few vitamins are recommended under specific circumstances.

Vegans and those over 50 may want to consider adding vitamin
B12, which is found naturally mainly in animal products and can be difficult
for older Americans to digest.

Women who are or may become pregnant are advised to take
folic acid to guard against neural tube birth defects.

The USPSTF recommends vitamin D for people over 65 who are
at risk of falls. Some doctors recommend it for their younger patients as well
because sunscreen and more time spent indoors limit our natural production of
the vitamin.

Yet, consumers who don’t fall into any of these risk groups spend
upward of $15 a month on vitamins. Market watchers and dieticians say consumers
do this because they know they eat poorly but can’t find the time to eat more vegetables,
fruits, and legumes. (There’s some evidence that a diet rich in fruits,
vegetables, and legumes prevents cancer, heart disease, and obesity.)

“What people are saying is, ‘I know I should be eating
better. I feel bad about that, but I either don’t want to do it or I don’t have
the motivation. I’m going to get a multivitamin and that’s going to make me
feel a little better — at least I’m doing that,’” said Joan Salge Blake, MS, RD,
LDN, a dietician at Boston University.

I encourage [patients] to look at their food choices and make changes in food first before resorting to pills.

Katie Ferraro, University of California, San Francisco.

An American eating a pretty average diet runs little risk of
developing a vitamin deficiency, according to the Office of Dietary Supplements
in the National Institutes of Health. Only about 10
percent of Americans have vitamin deficiencies, according to a national
survey from 2003-2006.

The rest of us can easily get what we need, even with the
minimum requirements of fruits and vegetables and the occasional bit of
enriched flour or breakfast cereal.

“I encourage [patients] to look at their food choices and
make changes in food first before resorting to pills,” said Katie Ferraro, MPH,
RD, a dietician at the University of California, San Francisco (UCSF).

No One Inspects Supplements Before They Hit Store Shelves

Vitamins, and before them elixirs, have long held a
particular sway over American consumers. The Food and Drug Administration (FDA)
was established in 1906 to solve the same problem American consumers still, to
a lesser degree, face: What is a genuine medicine and what is snake oil?

The Federal Trade Commission (FTC) came along about a decade
later, tasked with making sure that marketers don’t make false or
unsubstantiated claims about their products.

Since then, both agencies have had their hands full trying
to figure out how best to regulate vitamins and supplements, and how to enforce
those regulations for millions of products.

Supplement makers have to adhere to the FDA’s good
manufacturing guidelines. They’re required to accurately identify the
ingredients their products contain — but as the recent crackdown by the New
York Attorney General’s office reveals, they don’t always do so.

With a limited budget, the FDA only spot tests about 1
percent of the 65,000
dietary supplements on the market, according to Todd Runestad, editor of the trade publication Functional Ingredients and the Engredea reports.

Dietary supplement makers aren’t required to prove their
supplements have any effects on health. And only ingredients developed after
1994 must be tested for safety before they hit the shelves.

There are a lot of consumers out there who think that these products wouldn’t be on the market with these claims if they hadn’t been reviewed by some government agency.

Rich Cleland, Federal Trade Commission

If a supplement results in “adverse events,” however, the
FDA can pull it. The agency used this authority to ban
the herbal weight loss supplement ephedra in 2004 after it led to eight deaths.
In 2013, the FDA recalled
OxyElite after it led to several cases of liver failure.

“There are a lot of consumers out there
who think that these products wouldn’t be on the market with these claims if
they hadn’t been reviewed by some government agency. There’s a large number of people
who think that and it’s a myth,” said Rich Cleland, assistant director
of the FTC’s Division of Advertising Practices.

The FTC, meanwhile, guards against false
advertising. That job sometimes requires poring over the scientific studies on
which marketers base their claims to see if they are real or junk science,
according to Cleland.

Critics think the loose government regulations allow
supplements to remain unchecked while being advertised as medical care. But others
think regulators are in the pockets of special interests that don’t want
supplements on the market in the first place.

“There’s lots of research, it’s just that the disease treatment
system does not acknowledge that there are more than two states — healthy and
diseased. The FDA is a wholly owned subsidiary of Big Pharma, and they’re
there to protect the interests of Big Pharma,” said Runestad.

From the Wild West to Supplement City

There have been a number of efforts to develop tighter
regulatory control. In 1976,
the FDA moved to regulate vitamins that contained more than 150 percent of the
recommended daily allowance as drugs. Congress forbade the agency from doing
so.

In the early 1990s, Congress considered several bills that
would have expanded the powers of the FDA. The Nutritional Labeling and
Education Act of 1990 imposed stricter labeling rules on food products. At the
urging of Senator Orrin Hatch, a Utah Republican, the law exempted dietary
supplements. Utah is home to many dietary supplement companies, whose combined
value exceeds $5 billion, according to NASDAQ.

DSHEA, which insiders pronounce duh-SHAY, didn’t go so far as to allow herbal supplements to claim
on their labels that they cure, treat, or prevent any diseases, but it ushered
in more general health claims, such as “supports healthy immune function.”
Passage of the law led to an explosion in the industry.

Since then, lawmakers have tried to patch some of the
problems with DSHEA, but the industry has resisted.

In 2006, a new law required
dietary supplement makers to report serious adverse health events linked to
their products. But a 2010 law requiring reporting of all adverse events died in the Senate.

And in 2013, a bill that would have given the Institute of
Medicine the power to screen the ingredients in supplements also died without
reaching a vote. Supplements makers lobbied
hard against both bills.

What’s in the Bottle?

For their part, consumers seem content. Even with the
Preventive Services Task Force concluding that vitamins don’t prevent cancer or
heart disease, the market grew 3 percent in 2013.

In recent years, the industry has been growing about as fast
as the Chinese economy, according to numbers from Euromonitor. It has expanded
40 percent since 2008.

The trouble is, there’s really no way for consumers to know
what they’re buying.

Although the FDA only tests a tiny fraction of vitamins and
herbal supplements, it regularly turns up banned
and prescription
drugs in weight loss and sexual enhancement supplements.

These supplements inhabit the darkest corner of the industry,
driven by high profit margins and a small chance of getting caught, experts say.

“DSHEA creates perverse incentives for
unscrupulous manufacturers to out-compete legitimate companies by adding
undeclared, illegal ingredients including prescription medications, banned
drugs, and even entirely novel chemical compounds,” Dr. Pieter Cohen, an
assistant professor at the Harvard Medical School, wrote
last year in the Harvard Public Health Review.

Cohen and some colleagues tested
supplements that were back on the shelves about a year after being recalled by
the FDA for containing prescription drug ingredients. More than 60 percent
still contained the banned drugs.

Sometimes new herbal ingredients, particularly in weight
loss products, prove just as dangerous. A novel ingredient in the weight-loss
supplement OxyElite was linked to several cases of liver failure. The unsold
product the company was forced to destroy was worth $22 million.

Mister, of the CRN, called those who doctor their herbal products as "a part of the industry we try hard to marginalize."

Health-oriented herbal supplements and vitamins are a safer
bet, but they aren’t trouble-free.

Last month, the New York Attorney General’s office conducted
its own testing of six popular herbal supplements — including garlic, echinacea,
and saw palmetto — offered by major retailers.

According to the tests, 20 percent of the
products matched
their labels, while nearly 80 percent contained none of the product on the label
or were contaminated with other plant material. None of the unlabeled
ingredients was dangerous, except potentially to those with food allergies.

Industry groups contend that the
government used the wrong testing method. A garlic supplement doesn’t contain
garlic; it contains the active ingredient in garlic, they argue.

But Dr. Steven
Heymsfield, a nutrition and obesity expert at Louisiana State University,
said that critique is laughable. The industry works by sowing small seeds of
doubt about scientific studies of their products, he said.

Consumers need to realize that what they’re purchasing in a bottle is completely different from what an ancient herbalist would have used.

Pieter Cohen, Harvard Medical School

“A high-school student could do those analyses,” he said.
“Give me a break.”

For Cohen, that is the best reason to stick
to foods thought to have health benefits, such as turmeric, ginger, and
cranberry, instead of buying their packaged equivalents.

“There may be evidence that some
botanicals in their pure state have medicinal effects,” he said. “But consumers
need to realize that what they’re purchasing in a bottle is completely
different from what an ancient herbalist would have used, making it extremely
unlikely that these highly processed products are going to confer any of the
theoretical health benefits — even if they’re made from the plants they say
they are.”

The Story of a Pill

Heymsfield has done scientific research of his own on
whether herbal weight loss supplements work. In addition to early research into
ephedra, he worked in 1998 with a company that was interested in marketing
garcinia cambogia, an ingredient in the tropical fruit tamarind also sometimes
called hydroxycitric acid.

The study, published in the Journal of the American Medical Association, found that garcinia
cambogia made no difference for weight loss. Others in the supplements industry
critiqued the findings, but no study has refuted Heymsfield’s results. Because
any unpatented substance found to promote weight loss would be wildly
profitable, a lot of companies have looked into garcinia cambogia.

“Nestle, Dannon — all these companies have used a high-power
microscope to look at those things and have walked away,” Heymsfield said.

I think if you imply a claim or you make a claim you should have to prove it scientifically and usually that means doing a genuine study. Otherwise you’re in a no man’s land.”

Dr. Steven Heymsfield, Louisiana State University

But in late 2012, the telegenic Dr. Mehmet Oz called garcinia
cambogia “a revolutionary fat buster.” Google search queries for the
obscure herb shot
up. After Oz went before Congress and admitted there was no
scientific evidence to support this or other product endorsements he’d made on
his show, search volume fell off, but not by much.

What is a fair way to regulate ingredients like garcinia
cambogia?

“You don’t want to make foods require the same level of evidence
that drugs do — nobody could afford the foods,” Heymsfield said. “There must be
a lower level of claims that are acceptable. Maybe I’m conservative on this, but
I think if you imply a claim or you make a claim you should have to prove it scientifically
and usually that means doing a genuine study. Otherwise you’re in a no man’s
land.”

The doctors and dieticians Healthline
spoke to recommended waiting for a doctor to advocate any vitamins or
supplements — or at the very least, clearing them with a doctor first.

If one multivitamin provides 100 percent daily value, it doesn’t mean that one providing 1,000 percent is 10 times better.

Katie Ferraro, University of California, San Francisco

Some herbs can interact badly with certain
prescription medicines, and vitamins if taken in high dosages can be dangerous.

“If one multivitamin provides 100
percent daily value, it doesn’t mean that one providing 1,000 percent is 10
times better,” said USCF’s Ferraro.

For those who want to take a single multivitamin
as an insurance policy, mainstream medical advice can be boiled down to indifference.

“You’re not likely to do any
harm with a multivitamin, but it may not be doing any good either,” said
Haggans of the NIH.

Stand-alone vitamin supplements, unless
recommended by a doctor, are riskier.

“When people start buying individual
supplements, the doses tend to be a little higher. You need to be a little more
wary of it when you start doubling up on things. It can happen that people go
too far,” said Haggans.

None of the dieticians or doctors Healthline
spoke to endorsed any specific herbal supplements.

Even Runestad, an advocate who takes
many vitamins and other supplements personally, acknowledged there is “a
problem of ingredient adulteration.” But it’s easy to stay safe by buying
reputable brands. He recommended several brands including Gaia Herbs, Herb
Farm, Source Naturals, Doctors Best, and Nature’s Way.

Cleland of the FTC also specifically cautioned against
buying unfamiliar brands online.

In the end, all conclude that healthy food is the cheaper
and the better option.

“We’re smarter than we were years and years ago,” said
dietician Blake. “Now we know there are phytochemicals
and fiber in fruits and vegetables that are working to prevent cancer, and you
can’t put those in a pill.”